Respiratory
Respiratory Notes: Asthma, COPD, Cor Pulmonale, Pulmonary Embolism and Others
Compact notes on asthma (acute and long term), acute exacerbation of COPD, allergic rhinitis, pulmonary embolism, haemoptysis, aspiration pneumonia, lung abscess, interstitial lung disease, sarcoidosis and pulmonary hypertension.
- ICD-10
- —
- Source
- OPD handbook pp.215–216 (lower band of the handwritten sheet and a following page; partly legible)
- Status
- Draft
Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.
Symptoms
Treatment
Step 1 of 12
Allergic rhinitis
- Tab Kestine (ebastine) 10 mg OD, or Baconase (beclomethasone) nasal spray, or Rynacrom (sodium cromoglicate) nasal spray
Step 2 of 12
Asthma: severe attack
- O2
- Nebulise with Ventolin (salbutamol) 2.5–5 mg diluted in 5–10 mL N/S, repeat in 60 minutes
- Inhaler Ventolin / Inj Ventolin 250 mcg
- Inj Solu-Cortef 200 mg IV 6-hourly
- Neb Atrom (ipratropium) 250 mcg diluted in 10 mL N/S
- Tab Augmentin (if infection)
- If no response: Inj Aminophylline 250 mg IV slowly over 20 minutes; Inj MgSO4 1.2–2 g when the patient is stable
- Then: Ventolin inhaler + Bekson inhaler; Tab Prednisolone 5 mg tapered over 0–2 weeks
Step 3 of 12
Asthma: long-term management (steps)
- Step 1: Inhaler Ventolin as required; if required more than once daily or more than 3 times weekly, go to step 2
- Step 2: Inhaler Bekson (2–4 puffs daily) + Ventolin inhaler
- Step 3: Inhaler Foster (formoterol + beclomethasone) 2 puffs BD + Ventolin inhaler
- Step 4: the above + Cap Respro (theophylline) 200/300 mg OD; Tab Montelukast 10 mg at bedtime; Tab Ventolin 4/8 mg
- Step 5: add Tab Prednisolone 5 mg
Step 4 of 12
COPD: acute exacerbation
- O2 1–3 L/min by nasal cannula
- Neb Ventolin + Atrovent
- Inj Solu-Cortef 100 mg IV BID
- Tab Prednisolone 5 mg TID
- Cap Respro SR 200 mg BID
- Antibiotics for 7 days: Cap Amoxil 500 mg TID; Cap Vibramycin 100 mg BD
- Chest physiotherapy; mechanical ventilation if needed
Step 5 of 12
COPD: long-term management
- Inhaler Ventolin + Atrovent; Cap Respro SR 200 mg BD; Inhaler Bekson if needed
- Long-term domiciliary oxygen at 2 L/min by nasal cannula for 15 hours a day
Step 6 of 12
Cor pulmonale
- COPD treatment + Tab Moduretic OD in the morning
Step 7 of 12
Pulmonary embolism
- O2 + Inj heparin 5000 units IV bolus followed by 20,000 units in 5% dextrose infusion at 15–25 U/kg/hr (monitor aPTT 1.5–2× control)
- Inj Clexane (enoxaparin) 1 mg/kg SC BD for 5–10 days
- From day 2 add Tab Coumadin (warfarin) 5 mg BD (INR 2.5–3 × control); continue warfarin for 2 months, or Tab Xarelto (rivaroxaban) 15 mg BD (as read)
- Thrombolysis in massive PE
Step 8 of 12
Haemoptysis (above 600 mL over 48 hours)
- Position, O2, bed rest
- Tab Lexilium (bromazepam) 3 mg, 1 OD
- Cap Transamin 500 mg TID
Step 9 of 12
Aspiration pneumonia
- O2 + IV fluids
- Inj Augmentin IV 600 mg TID
- Inj Flagyl IV 500 mg TID
- Inj Gentacin 80 mg IV TID
Step 10 of 12
Lung abscess
- Postural drainage and culture/sensitivity; treat for 4–6 weeks
- Tab Augmentin BD; Tab Peflox 500 mg OD (as read); Tab Mofest 400 mg OD; Tab Dalacin C 300 mg TID (clindamycin); Tab Flagyl 400 mg TID
Step 11 of 12
Allergic alveolitis, sarcoidosis, fibrosing alveolitis
- Allergic alveolitis: Tab Prednisolone 5 mg, tapered over 2–6 weeks
- Sarcoidosis: Tab Prednisolone 5 mg TID (2–3 tabs), tapered over 1 year
- Fibrosing alveolitis: Tab Prednisolone 5 mg 2–3 tabs TID, tapered off, plus O2; if relapse add Tab Imuran 25 mg 1–2 tabs daily BD (the page writes 'azithromycin' beside Imuran; Imuran is azathioprine)
Step 12 of 12
Pulmonary hypertension
- Tab Norvasc (amlodipine) 10 mg, 1–2 OD
- Tab Bosmon (bosentan) 62.5 mg, 1–2 OD